Red Eye - Common Causes, Diagnosis and Treatment.pptx

Red eye is a non-specific term that is used to describe an eye that appears red due to intraocular or extra-ocular pathologies which can be as a result of infections, inflammations, allergies or trauma.

It is usually as a result of vasodilation in the anterior portion of the eye. It is a sign of an underlying disease, not a diagnosis.

1. RED EYE AKINTOLA O.O, AITO I.T

2. OUTLINE Introduction Epidemiology Brief anatomy of the eye Common causes of red eye Diagnosis Conclusion

3. I ntroduction Red eye is a non-specific term that is used to describe an eye that appears red due to intraocular or extra-ocular pathologies which can be as a result of infections, inflammations, allergies or trauma. It is usually as a result of vasodilation in the anterior portion of the eye. It is a sign of an underlying disease, not a diagnosis.

4. Epidemiology Red eye is a very common presentation. C onjunctivitis and sub-conjunctiva hemorrhage are the common causes. The exact figures are not available as many are asymptomatic and so go under-reported Red eye can occur at all age groups depending on the aetiology There is no gender or racial predilection

5. Brief anatomy

6. Causes of red eye Conjunctiva Viral conjunctivitis – adenovirus, poxvirus, coronavirus Bacterial conjunctivitis – S. pneumonia, H. influenza Allergic conjunctivitis – vernal keratoconjunctivitis , atopic keratoconjunctivitis Chlamydia conjunctivitis Sub-conjunctiva hemorrhage – trauma, hypertension , Pterygium

7. Causes of red eye

8. Causes of red eye Chlamydia conjuctivitis Subconjunctiva hemorrhage Pterygium

9. Treat ment Viral conjunctivitis Topical steroids Artificial tears for symptomatic relief Hand hygiene Discontinuation of contact lens Topical antibiotics if secondary bacteria infection is suspected

10. Treat ment Bacterial conjunctivitis – mostly self-limiting but topical antibiotics such as chloramphenicol, gentamicin, quinolones, polymixin B, etc , can be administered. Systemic antibiotics in cases of gonococcal , meningococcal and H. influenza infections Topical steroids Eye irrigation Hand hygiene Discontinuation of contact lens

11. Treat ment Allergic conjunctivitis Allergen avoidance, if possible Mast cell stabilizers and antihistamines Topical steroids

12. Causes of red eye Cornea Keratitis – bacterial, viral, fungal, parasitic, exposure Corneal ulcer Corneal abrasions Corneal laceration Foreign body impaction

13. Causes of red eye Fungal(A,C) and bacterial(B,D) Corneal ulcers keratitis

14. Causes of red eye Corneal abrasion Corneal laceration Foreign body

15. Bacterial keratitis T his is as a result of the entry of pathogens either through a compromised or intact cornea Organisms that cause bacterial keratitis via compromised barrier include S. aureus , P. aeruginosa Those that penetrate the intact cornea are N. gonorrhea, H. influenza, Meningitides Risk factors Contact lens wear Injury Ocular diseases like VKC, blepharitis

16. Bacterial keratitis Clinical features Painful red eye Purulent discharge Chemosis Photophobia Stroma infiltrates Hypopyon Corneal ulceration

17. Viral keratitis Causative agents: Herpes zooster , Herpes simplex Clinical features Painful red eye Photophobia Watery discharge Grayish corneal opacity Foreign body sensation

18. Fungal keratitis Causative agents include: Candida spp , Aspergillus Risk factors Contact lens wear Trauma Chronic use of topical steroids Clinical features Slow course Painful red eye Stroma infiltrates Hypopyon

19. Causes of red eye Anterior uveitis – inflammation of the uvea; iris, choroid, cilliary body. It can be acute or chronic. Iritis Iridocyclitis

20. Acute anterior uveitis -Sudden onset of unilateral ocular pain - Photophobia - Blurry vision - Peri-limbal / circum -corneal redness/ciliary flush - Tearing - Miosis - Keratic precipitates -Posterior synechiae - Aqueous flare and cells -H ypopyon -A nterior vi treous cells (iridocyclitis)

21. Chronic anterior uveitis Usually as ymptom atic until complications occur Reduced v ision - uni-/bilaterally ±Redness Aqueous cells/Flare Keratic precipitates -pale, irregular Iris atrophy Band Keratopathy Cataract Hypotony Glaucoma

22. Treat ment Mydriatics – short acting ( tropicamide , cyclopentolate ) and long acting (atropine, hematropine ) Topical steroids Management of complications of chronic anterior uveitis

23. Acute angle-closure glaucoma When some fluids builds up in the front of the eye, this puts much pressure on the eye, engorging the blood vessels of the sclera and can also lead to the damage of the optic nerve Some symptoms include: Severe pain in the eye Headache Decreased or blurry vision Rainbows or halos in your vision Nausea and vomiting Fixed mid-dilated pupil Elevated Intra ocular pressure (stony hard globe)

24. Acute angle-closure glaucoma Diagnosis History taking Eye examination Tonometry Treatment Drugs: miotics, sympatholytic drugs, sympathomimetic, prostaglandin analogues, carbonic anhydrase inhibitor Surgical: trabeculectomy, peripheral iridectomy, trabeculoplasty

25. Episcleritis This is an inflammatory condition affecting the episcleral tissue between the conjunctiva and the sclera that occurs in the absence of an infection. The causes of episcleritis is mostly unknown. It sometimes flares up when you are tired , have been reading or working for long periods on computers or are in a dry, dusty environment Can be classified as Simple; with redness in a section and sometimes throughout the comfort the eye with minimal discomfort

26. Episcleritis - Or Nodular; with slightly raised bumps surrounded by dilated blood vessels, usually in one area of the eye that may cause discomfort

27. Episcleritis Clinical features include Tearing, Sensitivity to light, A hot prickly, or gritty sensation in the eye Diagnosis Is typically based upon the history and physical examination and also the use of phenylephrine 2.5% Treatment Corticosteroid eye drop, artificial tear eye drops, NSAIDs eg ibuprofen

28. Scleritis This is the inflammation in the episcleral and sclera tissues with injection in both superficial and deep episcleral vessels. It may involve the cornea, adjacent episcleral and the uvea and thus can be vision threatening. Scleritis is often associated with an underlying systemic disease in up to 50% of patients Clinical features : Severe pain Tenderness of the eye Inflammation of the white part of the eye Blurred vision Tearing Extreme sensitivity to light

29. Scleritis Classification: Anterior: this is when the front of the sclera is inflamed, it’s the most common type of scleritis Posterior Scleritis: this is when the back of the sclera is inflamed, its less common but can lead to serious eye problems like detached retina or glaucoma Diagnosis History taking and fundoscopy/ophthalmoscopy Treatment: Medical: NSAID, Steroid, Immunosuppressive, Immunomodulators Surgical: in cases of perforation or excessive thinning

30. References Clinical Ophthalmology: A Systemic Approach. 7 th edition. J.J Kanski , Brad Bowling. www.medscape Lecture notes on ophthalmology. 9 th edition. Bruce James, Chris Chew, Anthony Bron .